Week 4 - Spinal Cord Injury Flashcards
What is a spinal cord injury?
Mechanical disruption to the structure & function of the spinal cord & spinal nerve pathways.
Can be a traumatic or non traumatic injury
What causes a traumatic spinal cord injury?
Damage to the spinal cord resulting from a traumatic event, fall or accident usually occurs from a fracture and/or dislocation of the spine. May also be the result of penetrating injuries from:
displaced bony fragments penetrating the spinal cord and/or the spinal nerves. bullets or weapons.
What causes a non-traumatic spinal cord injury?
Vascular disorders, tumours, infections or haematomas causing cord compression
What are the types of spinal cord injury?
Transient concussion (reversible)
Contusion (bruising)
Laceration (cut to the cord)
Compression (Squashed)
Transection (irreversible, cut through the cord)
What are some of the symptoms of a spinal cord injury?
Symptomsdepend ondegree of paralysis & potential for rehabilitation depends on the level of lesion
- Paralysis from below level of injury
- Loss of reflexes
- Loss of bowel, bladder and sexual function
- Muscle spasm
- Inability to control body temperature
- Loss of bone density
- High risk of pressure injury
What is the patho of a spinal cord injury?
- Microscopic haemorrhages occurs in the central grey matter and pia matter
- Tissue volume is increased, causing compression and necrosis
- Oedema occurs in the white matter, causing impaired circulation throughout spinal cord
- The haemorrhage and oedema obstruct blood flow and lead to further ischaemic areas
- Leads to functional impairment which may be temporary or long term
What are some nursing interventions for spinal cord injuries?
- Encourage independence but assist with ADLS
- Assist with bowel/bladder cares
- Prompt pressure area cares
- Regular position changes
- Ensure environment is clutter free
- Provide education surrounding rehab
What are some secondary spinal cord injuries?
Ischaemia
Hypoxia
Oedema
Inflammatory Process
What functions will be lost with a complete spinal cord injury?
Voluntary movement
Sensation of pain, temperature, pressure & proprioception
Bowel and bladder function
Loss of reflexes
What vertebrates are important in testing motor function?
C5-Elbow flexion L2-hip flexion
C6-wrist extension L3-knee extension
C7-elbow extension L4-ankle dorsiflexion
C8-finger flexion L5-toe extension
T1-finger abduction S1-ankle plantar flexion
What are the complications of spinal cord injury?
Spinal Shock
Neurogenic Shock
Autonomic Dysreflexia
What is Spinal Shock?
- Areflexia (sudden depression reflex activity) < level injury
- Muscles paralysed, flaccid and without sensation below level of injury
- Bowel and bladder function lost
- Gastric stasis
- Paralytic ileus
What is Neurogenic Shock?
Loss of autonomic control leads to:
- ↓ BP, ↓ HR
- Peripheral venous pooling
- Priapism
- Loss of temperature control
- Lack of perspiration below level of injury
What is Autonomic Dysreflexia?
Occurs after spinal shock has resolved in persons with SCI above T6. Stimulus causes sympathetic nerves to become overactive
inhibitory nerves from brain travelling down spinal cord serve to moderate all spinal cord reflexes thus if someone taps your knee - your leg kicks. This is a spinal reflex
Simple response to painful stimulus makes your body react with reflexive sympathetic response at spinal cord level as well as increasing B/P. Normal circumstances inhibitory nerves from brain moderate response.
What is the possible aetiology of Autonomic Dysreflexia?
Urinary retention
Over distended bladder or bowel
Pressure ulcers
Kidney stones
Ingrown toenail
